An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature.

BACKGROUND: The Swiss staging model for hypothermia uses clinical indicators to stage hypothermia and guide the management of hypothermic patients. The proposed temperature range for clinical stage 1 is < 35-32 °C, for stage 2 is < 32-28 °C, for stage 3 is < 28-24 °C, and for stage 4 is below 24 °C. Our previous study using 183 case reports from the literature showed that the measured temperature only corresponded to the clinical stage in the Swiss staging model in approximately 50% of cases. This study, however, included few patients with moderate hypothermia. We aimed to expand this database by adding cases of hypothermic patients admitted to hospital to perform a more comprehensive evaluation of the staging model. METHODS: We retrospectively included patients aged ≥18 y admitted to hospital between 1.1.1994 and 15.7.2016 with a core temperature below 35 °C. We added the cases identified through our previously published literature review to estimate the percentage of those patients who were correctly classified and compare the theoretical with the observed temperature ranges for each clinical stage. RESULTS: We included 305 cases (122 patients from the hospital sampling and the 183 previously published). Using the theoretically derived temperature ranges for clinical stages resulted in 185/305 (61%) patients being assigned to the correct temperature range. Temperature was overestimated using the clinical stage in 55/305 cases (18%) and underestimated in 65/305 cases (21%); important overlaps in temperature existed among the four stage groups. The optimal temperature thresholds for discriminating between the four stages (32.1 °C, 27.5 °C, and 24.1 °C) were close to those proposed historically (32 °C, 28 °C, and 24 °C). CONCLUSIONS: Our results provide further evidence of the relationship between the clinical state of patients and their temperature. The historical proposed temperature thresholds were almost optimal for discriminating between the different stages. Adding overlapping temperature ranges for each clinical stage might help clinicians to make appropriate decisions when using clinical signs to infer temperature. An update of the Swiss staging model for hypothermia including our methodology and findings could positively impact clinical care and future research.

[Recreational drugs: the complication's pleasure?]. / Drogues récréatives: le plaisir des complications?

Steadily increasing since 1990, the use of psychoactive substances was expanded to new designer drugs (bath salts, spice) with so original still unknown pharmacological effects. At the beginning, the pleasure, first feeling, turns sometimes, in acute medical emergency and then, in some cases, in chronic diseases. Side expected or not desired effects, seen in emergency departments could be necrotizing gangrene among consumers Krokodil or dystonic reactions in consumers of Spice. Moreover, adulterants could increase the dangerosity of the substances. Searching a toxidrome helps to find the incrimining substance.

[Level of satisfaction in the emergency department. What about the residents?]. / Satisfaction aux urgences ou urgence de satisfaction. Qu'en est-il des assistants?

Emergency medicine is evolving within medical departments that are or will be experiencing major restructuring. The interdisciplinary organization of the emergency department (ED) is the result of a long reflexion from hospital managers or health professionals facing a real challenge: find an answer to the population's needs while providing a good and safe health system. For young residents, working in an interdisciplinary model implies to practice in an emerging specialty that they might not have chosen. Hence, there is no official assessment method allowing residents to give a feedback of their work in the ED. With this survey, we wanted to have the opinion and the feeling of young doctors that worked in such an interdisciplinary model.

[Animal bites and infection]. / Morsures d'animaux et risque infectieux.

Animal bites, mostly dog bites, often require an emergency department visit, but are often mistakenly considered innocuous. Indeed, bite wounds can lead to an handicap as well as become infected, mostly with the oral flora of the biting animal (Pasteurella, Capnocytophaga, Eikennella, streptococci, staphylococci and anaerobic bacteria). Bites can also cause other infections like tetanus, rabies, cat scratch disease, tularemia, leptospirosis, rat-bite fever and plague. The management of bite wounds includes prophylactic (antimicrobial prophylaxis, tetanus and rabies immunization) and therapeutic aspects (local treatment and antimicrobial therapy).

[Spontaneous hemoperitoneum: diagnosis, prognosis and possible therapeutics]. / L'hémopéritoine spontané: diagnostic, pronostic et thérapeutiques possibles.

We report the case of a 58-year-old diabetic man admitted to the hospital in a comatose state due to medicamentous hypoglycemia in a context of hypovolemic acute renal failure. Hypovolemia was due to hemoperitoneum in a alcoholic patient with cirrhotic hepatic failure. CT-scan and arterial angiographies revealed a voluminous isolated hepatic mass with active bleeding suggesting the diagnosis of spontaneous bleeding from a hepatocellular carcinoma. The hemorrhage resolved after selective arterial embolization, but the patient died two weeks later from an infectious cause. The differential diagnosis of a spontaneous hemoperitoneum and possibilities of treatment in the case of ruptured hepatocellular carcinoma are discussed.

[Atrioventricular heart block in Lyme disease]. / Bloc atrioventriculaire complet sur borréliose de Lyme: aspects etectrocardiographiques, diagnostiques et microbiologiques.

Lyme disease is the most common tick-borne disease in Europe and in the United States. In comparison to dermatological, neurological and rheumatological manifestations, heart disease is quite rare. Atrioventricular heart block is nevertheless the most frequent cardiological manifestation. We hereby report the case of a patient with high degree heart block due to Lyme disease. We focus on the electrocardiographical evolution during antibiotic therapy, as well as on microbiological and diagnostic aspects. Lyme disease is a rare cause of conduction disturbances but it is treatable and potentially reversible.